Explore the vast range of titles available.

Ghana has committed politically, legislatively, and fiscally to providing universal health insurance coverage for its population with the intent of reducing financial barriers to utilization of health care.. However, under current cost and enrollment projections the system will not be financially sustainable in the long term, so there is more work to do. This book provides an important evidence-based review of the current performance of Ghana's health system and options for reform. As such, it provides an overall picture of the Ghana health sector, how things were and how things have changed, as well as a situational analysis of the performance of the health delivery and health financing systems using the latest available data. Finally, it discusses key reform issues and options in the context of the country's likely fiscal space. An important and valuable contribution of this book is its examination of how Ghana is performing compared to its neighboring countries and compared to other countries with similar incomes and health spending, providing global benchmarks for Ghana's health system performance.

Abstract This is a methodological study for the development and validation of the Multidimensional Instrument for Evaluating of the Implementation of Psychosocial Care Network (IMAI-RAPS) in Minas Gerais (MG)/Brazil. The study was carried out in three stages: evaluability study, development of the IMAIRAPS, application of the Delphi Technique for content and appearance validation of the questions. The analysis of official documents, literature review and a structured engagement with program members were carried out to clarify its operationalization and focus on the central aspects to be evaluated. A theoreticallogical model of RAPS was built according to the Donabedian triad: structure, process and result and organized into: Minimum Units (Mental Health Care and Psychosocial Rehabilitation), Connectivity (Network Articulation), Integration (Governance and Management of the Care), Normativity (Mental Health Policy and Participation and Social Control), Subjectivity and Structure (Services, Logistics System and Health Education). The IMAI-RAPS was derived from this model, which was validated by 44 experts in the field, indicating the approach of relevant, useful and viable questions for evaluating the structure and process of implementing the program in MG. The use of the Delphi Technique made it possible for the developed products to be marked out by Psychosocial Care Network scholars or professionals from different regions of the country, increasing the analytical power of the tool. Resumo Trata-se de um estudo metodológico para desenvolvimento e validação do Instrumento Multidimensional para Avaliação da Implantação da RAPS (IMAI-RAPS) em Minas Gerais (MG)/Brasil. O estudo foi executado em três etapas: estudo de avaliabilidade, desenvolvimento do IMAI-RAPS, aplicação da Técnica Delphi para validação de conteúdo e aparência das questões. Foram realizados a análise de documentos oficiais, revisão da literatura e um engajamento estruturado com membros do programa para esclarecer sua operacionalização e focalizar os aspectos centrais a serem avaliados. Um modelo teórico-lógico da RAPS foi construído de acordo com a tríade donabediana: estrutura, processo e resultado e organizado em: Unidades Mínimas (Assistência à Saúde Mental e Reabilitação Psicossocial), Conectividade (Articulação da Rede), Integração (Governança e Gestão do Cuidado), Normatividade (Política de Saúde Mental e Participação e Controle Social), Subjetividade e Estrutura (Serviços, Sistema Logístico e Educação em Saúde). Desse modelo derivou-se o IMAI-RAPS que foi validado por 44 experts da área indicando a abordagem de questões relevantes, úteis e viáveis para avaliação da estrutura e processo de implantação do programa em MG. A utilização da Técnica Delphi possibilitou que os produtos desenvolvidos fossem balizados por estudiosos ou profissionais da RAPS de diversas regiões do país aumentando o poder analítico da ferramenta.

Abstract The present study aims at analyzing the regionalization of the services carried out by the Psychosocial Care Network (RAPS in Portuguese) in the state of Minas Gerais (MG) in Brazil, yielding indicators that may enhance the SUS strategic management towards the strengthening of the psychosocial care provided by the state. It is a cross-sectional study, based on the data collected in May 2019 from government websites, considering the state’s Macro-Regions and Health Regions as units of analysis. Indicators of service coverage in relation to the population in accordance to normative parameters determined by the Ministry of Health for a better understanding of the effective coverage were produced, and a general indicator (iRAPS) of the supply of services in this network in Minas Gerais state was validated. The outcomes allow a detailed analysis of the structural aspect of the RAPS in MG and unveil the development of a robust network. However, important regional heterogeneities were noticed and also a lack of services aiming at specific populations providing assistance 24 hours a day, which weakens the proper access to RAPS in several parts of the state. Higher values of iRAPS were found in health regions with low socioeconomic development and low general offer of health services, a fact that differs from the national scenario, which may imply state policy investments aiming at offering RAPS within the state hinterland areas. Resumo Objetivou-se analisar a regionalização dos serviços da Rede de Atenção Psicossocial (RAPS) em Minas Gerais (MG), Brasil, gerando indicadores que possam potencializar a gestão estratégica do SUS no fortalecimento da atenção psicossocial do estado. É um estudo transversal, realizado a partir de dados coletados em maio de 2019 em sites governamentais, tendo as Macrorregiões e Regiões de Saúde do estado como unidades de análise. Foram produzidos indicadores da cobertura de serviços em relação à população, de acordo com parâmetros normativos estipulados pelo Ministério da Saúde, para melhor compreensão da cobertura efetivada e validou-se um indicador geral (iRAPS) da oferta dos serviços dessa rede em MG. Os resultados encontrados possibilitam uma análise detalhada do aspecto estrutural da RAPS em MG e demonstram a implantação de uma rede robusta. Entretanto, percebem-se importantes heterogeneidades regionais e também uma carência de serviços voltados para populações específicas e com funcionamento 24 horas, o que fragiliza o adequado acesso à RAPS em diversos territórios do estado. Foram encontrados maiores valores do iRAPS nas regiões de saúde com baixo desenvolvimento socioeconômico e baixa oferta geral de serviços de saúde, fato que difere do cenário nacional.

BackgroundCommunity health worker (CHW) programmes, when adequately integrated into mainstream health systems, can provide a viable, affordable and sustainable path to strengthened health systems that better meets demands for improved child health, especially in resource-constrained settings. However, studies that report on how CHW programmes are integrated into respective health systems in sub-Saharan Africa (SSA) are missing.AimThis review presents evidence on CHW programmes’ integration into National Health Systems for improved health outcomes in SSA.SettingSub-Saharan Africa.MethodSix CHW programmes representing three sub-Saharan regions (West, East, and Southern Africa) were purposively selected based on their deemed integration into respective National Health Systems. A database search of literature limited to the identified programmes was then conducted. Screening and literature selection was guided a scoping review framework. Abstracted data were synthesised and presented in a narrative form.ResultsA total of 42 publications met the inclusion criteria. Reviewed papers had an even focus on all six CHW programmes integration components. Although some similarities were observed, evidence of integration on most CHW programme integration components varied across countries. The linkage of CHW programmes to respective health systems runs across all reviewed countries. Some CHW programme components such as CHW recruitment, education and certification, service delivery, supervision, information management, and equipment and supplies are integrated into the health systems differently across the region.ConclusionDifferent approaches to the integration of all the components depict complexity in the field of CHW programme integration in the region.ContributionThe study presents synthesized evidence on CHW programmes integration into national health systems in SSA.

Background The Spanish National Health System (NHS) faces a significant shortage of clinical psychologists with only 5.58 per 100,000 inhabitants. This study aimed to estimate the required number of specialists and residents in Clinical Psychology to provide adequate psychological treatments to the population in the NHS. Methods A needs-based model was adapted to forecast the required total number of clinical psychologists and the annual increase in the positions of residents in Clinical Psychology (PIR). This model followed five steps: (1) obtaining Spanish prevalence rates for three broad mental disorder categories (depression, anxiety, and others or severe mental disorders) from the 2017 National Health Survey (ENSE); (2) multiplying the prevalence rates by the Spanish population aged ≥ 15 years; (3) defining the percentage of cases eligible for treatment under three predefined scenarios (protocolized, intermediate, and adjusted); (4) operationalizing the characteristics of the three treatment scenarios (session number and duration); and (5) calculating the total number of clinical psychologists and the annual increase required for PIR positions. Results Depending on the treatment scenario, the estimations show a need for clinical psychologists ranging from 1665 to 13,527 for treating depressive disorders, 1792–9799 for anxiety disorders, and 2074–8294 specifically for severe mental disorders. On the other hand, depending on the treatment scenario and the timeframe to achieve the estimated number of professionals (within 3, 5, 8, or 10 years), for example, to achieve those estimations of professionals within 3 years, and according to the adjusted treatment scenario, the Spanish health system should offer approximately 481 PIR positions yearly during 3 years. Conclusions A significant increase in the number of PIR positions is necessary to meet the growing demand for psychological treatment in the Spanish NHS. Investing in a mental-health workforce can lead to substantial health and economic benefits. This study provides valuable insights for workforce planning and highlights the importance of addressing the shortage of clinical psychologists in the NHS.

Background In many universal health systems, waiting times act as a non-monetary rationing mechanism, one that should be based on clinical need rather than the ability to pay. However, there is growing evidence that among patients with similar levels of need, waiting times often differ according to socioeconomic status. The mechanisms underlying inequality in access remain unclear. Methods Using data for Spain, we study whether waiting times for primary and specialist care depend on patients’ socioeconomic status (SES). Additionally, we make use of the continuous nature of our data to explore whether the SES-related differences in waiting times found for specialist consultations vary among different points of the waiting time distribution. Results Our results reveal the presence of a SES gradient in waiting times for specialist services explained on the basis of education, employment status and income. In addition, for primary care, we found evidence of a slightly more moderate SES gradient mostly based on employment status. Furthermore, although quantile regression estimates indicated the presence of a SES gradient within the distribution of waiting times for specialist visits, the SES differences attenuated in the context of longer waiting times in the public sector but did not disappear. Conclusion Our findings suggest the principle of equal treatment for equal need, assumed to be inherent to national health systems such as the Spanish system, is not applied in practice. Determining the mechanism(s) underlying this selective barrier to healthcare is of crucial importance for policymakers, especially in the current COVID-19 health and economic crises, which could exacerbate these inequalities as increasing numbers of treatments are having to be postponed.

Background The most impacting direct costs associated to COPD for the National Health Systems (NHS) are those related to accesses to the emergency room and hospital admissions, due to the onset of one or more COPD exacerbations. At the same time, severe COPD treatment, that often require a combination of medicaments, represents a substantial economic burden for the National Health Systems (NHS). This study aimed to evaluate the potential saving deriving from the implementation in the prescription of the two currently available single-inhaler triple therapies (SITTs) versus the currently used multiple-inhaler triple therapies (MITTs) in an eligible COPD population residing in the Apulia Region. Methods A budget impact model was developed hypothesizing the progressive replacement of the different MITTs on the reference market (Scenario A) with the pre-established SITTs, assuming a degree of penetration of 30%, 50% and 100% (Scenario B). Drug costs were based on prices published on the Official Gazette and therapy durations were based on prescribing information over the year 2019 (IQVIA™ prescription dataset). Results Our analysis showed that the extemporaneous MITT with the highest prevalence on the reference market was the inhaled corticosteroids/long-acting β 2 -agonists (ICS/LABA) combination plus a long-acting muscarinic antagonists (LAMA). This association of medicaments was paradoxically also the one associated to the highest expense value. The expanded use of a pre-established ICS/LAMA/LABA SITT was associated to a significant economic saving, ranging from a minimum of -€ 1,108,814 (SITT use: 30%) to a maximum of -€ 3,658,950 (SITT use: 100%). The cheapest pre-established SITT contained the fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) combination. Conclusion A pre-fixed ICS/LAMA/LABA SITT is cost-saving, compared to the different currently used extemporaneous MITTs. Clinicians should consider the potential benefits of finding less expensive regimens while maintaining adequate efficacy in the prescriptive decision making process of COPD patients.

In the Italian healthcare system, private facilities can supplement public ones in delivering services within the framework of the Italian National Health System, provided they meet specific conditions and obtain the necessary authorisations. This set of requirements is known as the ‘four As’ system, comprising authorisation for the construction of the facility, authorisation to provide healthcare services, accreditation, and contractual agreements. A crucial element in this regulatory framework is the system of tariffs for the remuneration of healthcare services, which are periodically established by the Ministry of Health through a complex procedure. This model of ‘administered competition’ aims to protect both citizens’ health and fair competition among healthcare providers. Proper integration of private facilities into the National Health System is intended to enhance the effi ciency of service delivery. Th e purpose of this paper is to examine the current regulatory framework governing the participation of private clinics in the Italian National Health System and to identify any critical issues.

Abstract This study explores the social and material processes involved in organizing time when developing policies and clinical practice. From the analysis of material produced during a case study focused on ethnographies and interviews on the health system in Chile, specifically of the Explicit Health Guarantees regime, we consider how the articulation between social activities and objects composes the temporal dimension in health. We analyze this by specifically considering the role of indexes and statistics in their biopolitical dimension and the local role of contingent and regular dispositions in clinical activity. We conclude with some implications on integrating a sociomaterial approach to the apprehension of time in health. Resumo Neste artigo, exploramos os processos sociais e materiais envolvidos na ordenação do tempo ao desenvolver políticas e práticas clínicas. A partir da análise do material produzido durante um estudo de caso baseado em etnografias e entrevistas sobre o sistema de saúde no Chile, especificamente sobre o regime de Garantias Explícitas de Saúde, consideramos o modo como a articulação entre atividades e objetos sociais compõe a dimensão temporal na saúde. Analisamos esse aspecto considerando especificamente o papel dos índices e das estatísticas na sua dimensão biopolítica, bem como o papel local das disposições contingentes e regulares na atividade clínica. Concluímos com algumas implicações da integração de uma abordagem sociomaterial na apreensão do tempo em saúde.

PurposeOut of Pocket costs (OOP) sustained by cancer patients also in public NHS contribute to disease-related financial toxicity. Aim of the study was to investigate the amount and the types of OOP sustained by Italian cancer patients for care services.MethodsA sample survey was conducted by FAVO in December 2017-June 2018, in 39 adhering hospitals and 1289 patients diagnosed from 1985 to 2018, by standardized questionnaire inquiring on: yearly expenditure by cancer service, age, year of diagnosis, disease phase, cancer site, sex, marital status, education, residence. Univariate and multivariable regression analyses were performed between OOP and each variable. Multilevel mixed-effects negative binomial regression was used to assess the combined effects of patients characteristics on the differences in acquiring health services.ResultsThe yearly average OOP was 1841.81€, with the highest values for transports (359.34€) and for diagnostic examinations (259.82€). Significantly higher OOP were found in North and Centre than South and Islands (167.51 vs. 138.39). In the fully adjusted multivariable analysis, the variables significantly associated with higher than reference expenditure were: medium/high education (OR 1.22 [1.05–1.42], upper gastrointestinal tract cancer (OR 1.37 [1.06–1.77]), disease phase of treatments for cancer progression or pain therapy (OR 1.59 [1.30–1.93]).ConclusionItalian cancer patients in 2018 sustained OOP quite similar to those measured in 2012 to supplement NHS services. The main component of the OOP costs were diagnostic examination and transportation. The NHS should pay attention to potentiate its ability to answer unmet needs of patients with advanced cancer who are the most fragile ones.Implications for cancer survivorsReinforcing the services where the main OOP expenses are located can help in promoting public health actions and reduce socio-economic needs that could compromise the receipt of optimal care along the whole disease course, from diagnosis to rehabilitation.